Psychiatry International

Heightened anxiety can impair perceptual-motor performance, with detrimental effects potentially arising, in part, from threat-related attentional biases and interpretations. Shifting from a flight (i.e., threat) mindset to a fight (i.e., challenge) mindset may be an effective strategy for coping with anxiety and improving performance on perceptual-motor tasks. In this context, the present study examined how differences in fight-or-flight behavioral goals, represented by hit or avoidance actions, influence attentional control in response to threatening stimuli during heightened anxiety. Healthy adult participants performed a visual probe task, with half responding to a probe target in hit mode and the other half responding in avoidance mode. Anxiety levels were manipulated using the threat-of-shock (ToS) method, which significantly increased the participants’ anxiety. Participants with avoidance goals exhibited significantly delayed responses when avoiding a target in the presence of threat-related stimulus cues under the ToS condition. Conversely, no changes in response times were observed between the ToS and no ToS conditions in those with hit goals. These results suggest that when anxiety is heightened, avoidance goals induce attentional biases toward threat-related stimuli. In conclusion, encouraging avoidance of potential threat-related sources as an action mode may be counterproductive for coping with heightened anxiety, at least in healthy adults. The study’s principal implication for clinical practice is that adopting fight-like behavioral goals in response to threats may be an effective strategy for managing anxiety in everyday life. Full article

The belief that people suffering from psychiatric disorders are more violent, in particular psychotic patients that do not have insight into their illness, is very common in the general population. Therefore, this review aimed to present a more accurate depiction of the link between lack of insight and violent behavior, by evaluating the existing scientific literature on the topic. For this purpose, a literature search on PubMed, Embase, and Google Scholar was conducted, selecting the relevant papers published during a 20-year period (2004–2024). The paper defined insight as a multi-dimensional concept and discussed its classification, explanatory models, and clinical implications, followed by a presentation of several insight-measuring scales. The meaning of violent behavior, its prevalence, underlying mechanisms, and different measuring scales were discussed, followed by the confounding factors that influence the relationship between insight and violent behavior, treatment options for violence in forensic psychiatry settings, and methods to improve medication adherence. Contrasting results were observed regarding the impact of each factor on leading to violent acts, which suggested that the relationship between insight and violence is more complex than previously thought. In conclusion, increased attention must be paid to the investigated dimensions of both the concepts and the confounding factors, with further research required on this topic. Full article

The study investigates the reliability and validity of the Greek version of the knowledge about childhood autism among health workers (KCAHQ) questionnaire. A total of 541 allied healthcare participants (n1 = 471 students; n2 = 70 professionals) provided their socio-demographic variables and completed the KCAHQ. Analysis showed overall floor-ceiling effects lower than 15% and skewness-kurtosis values between ±2. The internal consistency was good (Kuder–Richardson 21 = 0.80) and all domains were significantly correlated with each other, with Spearman’s coefficients ranging from 0.26 to 0.57. The split-half reliability was satisfactory, with the Spearman–Brown and lambda 4 coefficients equal to 0.618 and 0.613, respectively. All the goodness of fit indices generated by confirmatory factor analysis were acceptable (CFI = 0.88; TLI = 0.861, RMSEA = 0.052). Being a professional, having personal contact with an individual with autism, and having received autism-specific training significantly increased scores on the KCAHW. Overall, the Greek KCAHQ seems reliable and valid; however, domain 4 presents insufficient internal consistency. Full article

The high prevalence of anxiety and depressive symptoms in youngsters has resulted in two thirds of mental health problems emerging before the age of 25. In this context, various studies have indicated that attachment styles and emotional regulation are relevant factors for the health of this population. Likewise, a close relationship has been established between both constructs, associating secure attachment with greater regulatory skills and a lower risk of mental health problems. However, in Chile there are no studies that specifically analyze the influence of anxiety and attachment avoidance on emotional regulation, nor the influence of other factors such as biological sex. Therefore, the main purpose of this research was to analyze how these variables interact with each other. For this purpose, the Experience in Close Relationships Scale (ECR-R) and the Difficulties in Emotional Regulation Scale (DERS-E) were applied to a sample of 557 Chilean university students. The analysis of results, based on the construction of a moderated mediation model, revealed that anxiety and avoidance are predictors of emotional regulation difficulties. However, the influence of anxiety on emotional regulation would be greater than that of avoidance and would be moderated by biological sex, showing the need to design differentiated interventions for men and women. Full article

Women under treatment are a particular susceptibility group according to the classification of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). The average number of women under treatment is lower than men all across Europe, and the drop-out percentage is higher in women than men. The aim of this study was to investigate the factors associated with drug use problems among women under treatment. Methodology: Quantitative research. Data from 2179 people receiving recovery treatment were extracted from EuropASI surveys. The dependent variables in this study were (1) the patient’s family history of addiction and psychiatric disease, (2) the main substance consumed, (3) the lifelong and last month’s substance use, (4) the lifelong and last month’s emotional, physical and sexual abuse, and (5) the lifelong and last month’s psychiatric disorders (including suicide attempts). The factor was gender, taken as a dichotomous variable (male–female). Initially, the Kolmogorov–Smirnoff normality test and Levene’s test were used to understand whether the sample met the normality and homoscedasticity statistical assumptions. For quantitative variables, the Mann–Whitney U test was used. The confidence interval used was 95%. Results: Briefly, we found that women tend to consume more alcohol, use more medication, and suffer more depression, anxiety and suicidal ideation than men, both lifelong and in the last month. In addition, women suffer more abuses (emotional, physical, and sexual) than men, during their lifetime and in the last month. Conclusions: The data showed that women have specific needs and vulnerabilities that should be accounted for when providing treatment but are currently not. This situation evidences the need for specialized drug recovery programs for women, and not only that, programs must adapt to the needs of each woman’s particular situation. Moreover, it is pressing that a multifactorial approach is used in every intervention, given the multiplicity of factors influencing consumption and the evidence that fixed treatment programs are not satisfactorily intervening in the complex reality that surrounds people with addiction. Full article

Interoceptive awareness is currently gaining considerable attention and is in an active phase of research, supported by a growing body of empirical evidence from diverse fields such as neurophysiology, cognitive neuroscience, mind–body therapies, psychiatry, and psychometrics. The aim of this study was to examine the relationship between interoceptive awareness, anxiety, and depression in Peruvian adults. A total of 414 participants residing in Lima, Peru, were included, with 85% being young adults aged 18–27 years (252 women = 61%; 162 men = 39%; age range = 18–64; M age = 23.4). The results indicated that the indirect effect of interoceptive awareness on depression through anxiety accounted for 61.7% of the mediation, while the direct effect of interoceptive awareness on depression accounted for 38.3%. In conclusion, the hypothesis that anxiety negatively mediates the relationship between interoceptive awareness and depression in Peruvian adults was confirmed. This research may have implications in clinical settings, particularly for the prevention and psychotherapeutic intervention of anxiety and depression, through the promotion of adaptive interoceptive awareness. Full article

State-of-the-art literature has been enhancing the significance of personality phenomena in Alzheimer’s dementia (AD). This study seeks to identify the relationships of current and premorbid traits and abnormal dimensions in AD. Five-factor model and axis II personality disorders are taken as references. This research was conducted with two groups, which were assessed using the NEO-FFI and PDQ-4+ in individual interview sessions. Current personality measure: AD Group (n = 44 female participants); premorbid personality measure: AD group informants (n = 40 related participants). Findings suggest that in terms of both premorbidity and current studies, the relevance of the dimensions neuroticism (high) and conscientiousness (low), are the most common explanations found in the personality disorder scales, DSM clusters, Appendix B and the global personality disorder index. These data are relevant for the assessment of personality phenomena in Alzheimer’s disease. Full article

The comorbidity between late-life depression and neurocognitive disorders (NCDs) in the elderly is a subject of increasing interest within the scientific and medical community. We conducted a narrative review of clinical studies focused on depression and NCDs, primarily covering articles published over the past 25 years. Compared with younger adults, depression in the elderly is often characterized by difficulties in expressing sadness, more pronounced somatic, anxiety, and psychotic symptoms, as well as a heightened risk of suicide and cognitive impairment. Depressive symptoms in the elderly may mimic NCDs, act as prodromal signs of future NCDs, or represent a clinical dimension of dementia. NCDs and late-life depression share specific clinical similarities, particularly at illness onset, emphasizing the importance of early differential diagnosis to guide the development of precise, integrated, and tailored interventions. Full article

Despite their higher risk of mental health conditions, migrants often face barriers to accessing mental health care. This systematic review aims to synthesize the evidence on interventions to improve mental health care access for migrants (protocol CRD42024556575). PubMed, Embase, PsycINFO, and CINAHL were searched for experimental and observational studies on this topic. A narrative summary and a meta-analysis of the study findings are presented, along with a GRADE quality assessment. Eighteen reports, accounting for 3285 migrants, were included in the final selection. There were six randomized controlled trials, nine non-randomized clinical trials, and three observational studies. The interventions consisted of psychoeducation (27.8%), digital tools (22.2%), outreach programs, counseling, peer support (each 11.1%), and miscellaneous approaches (16.7%). There was marked heterogeneity in the intervention structure and outcome measure across the studies. Nevertheless, all studies reported a positive effect of the interventions on mental health care access. Still limited by few studies providing data suitable for the pooled estimate, the meta-analyses found a significant effect in reducing stigma and improving mental health literacy. Overall, this review identified promising interventions for improving migrant mental health care access. Future research is needed to validate interventions that can be applied sustainably across different contexts and migrant populations. Full article

The COVID-19 pandemic crisis has increased the vulnerability and decreased the retention in treatment of patients receiving medication-assisted treatment (MAT). Therefore, the aim of the present study was to investigate the impact of COVID-19 on craving and quality of life (QoL) of MAT patients and to reveal the potential role of medication dose. Thus, 562 volunteers were divided into the control group (n = 100) comprising healthy volunteers without prior contact with substances of abuse, and into the experimental group (n = 462), which included patients receiving MAT, who were stratified into sub-groups of patients under methadone and buprenorphine. The groups were further divided into two sub-groups, based on whether the participants were infected by SARS-CoV-2 or not. The heroin craving questionnaire (HCQ), and the Nottingham health profile (NHP) instrument were used for craving assessment and QoL evaluation respectively. The MAT patients who were infected by SARS-CoV-2 had higher levels of craving compared to their non-infected counterparts, and COVID-19 restriction measures reduced QoL mainly of non-infected MAT patients. Furthermore, low craving and high QoL were largely associated with medium or low medication dose. It appears that focused interventions and modifications to medication doses could lead to better clinical outcomes of the MAT programs and relapse prevention. Full article

Although the Parenting Stress Index-Short Form (PSI-SF) is widely applicable, there has been a dearth of research on the psychometric properties and item wording effects associated with the cultural sensitivity of the instrument. This study investigated the psychometric properties, the factor structure, and the negative and positive item wording effects of PSI-SF for 96 Latinx parents of children with intellectual and developmental disabilities in the United States within exploratory structural equation modeling, and structural equation modeling-based generalizability theory frameworks. This study produces the following noteworthy findings. First, the ESEM bifactor model with negatively and positively phrased items best captured the theoretical frameworks underlying the structure of the PSI-SF. Second, adding method factors enhanced the model fits of all the factor models. Third, this study discovered several items with great proportions of method factors. This study recommended that the items with high proportions of method factors, which may likely be culturally insensitive to Latinx parents, be examined further and refined. With the use of accurately assessed PSI-SF scores, practitioners will be better able to support and empower Latinx parents of children with IDD and better meet their needs through the FIRME program, a parent advocacy initiative. Full article

The aim of this article is to present a new marker of the degree of self-representation unity, developed from the Rorschach test, to assess the strength or fragility of psychotic patients’ narcissistic foundations. The marker exhibited discriminative value when comparing a group of paranoid subjects (n = 25) to two other groups of schizophrenic (n = 26) and paranoid schizophrenic subjects (n = 30). This indicator also appears useful for assessing the positive effects on the narcissistic Ego in psychotherapy. Full article

Numerous studies have linked lower levels of serum cholesterol with heightened aggression, violent crimes, and violent deaths across diverse populations, including forensic psychiatric patients, criminals, and the broad public. Interestingly, this association appears to be more pronounced in men than in women. Conversely, findings regarding serum triglycerides present a more nuanced picture, with some studies indicating heightened aggression with elevated levels and others suggesting the opposite. However, most studies have neglected to examine this phenomenon in conjunction with psychological traits. Additionally, no prior research has explored the association between serum lipid levels and different types of aggression, e.g., reactive, instrumental, or appetitive. Considering these gaps, our study aimed to assess serum cholesterol and triglyceride levels upon clinic admission and correlate them with scores from the Appetitive and Facilitative Aggression Scale (AFAS), a self-rating questionnaire assessing reactive and appetitive aggression. We conducted our investigation on a cohort of 135 forensic psychiatric patients undergoing drug addiction treatment under Section 64 of the German Criminal Code. This provision offers a nearly unique opportunity worldwide for individuals who have committed crimes under the influence of drugs or in the context of their addiction to receive specialized treatment. Using non-linear Spearman correlation analyses, we observed an inverse relationship between serum concentrations of both cholesterol and triglycerides and AFAS appetitive violence scores but not for reactive aggression. Additionally, triglyceride levels exhibited an inverse association with the prevalence of violent crimes as an index crime. In conclusion, blood lipids may affect numerous areas of health and disease beyond what is currently known, offering a potential shift in how we understand their role in aggression. Full article

The occupational environment may affect one’s psychophysical health by leveraging both external workplace stressors and individual psychological responses. We developed a comprehensive questionnaire to assess occupational stress among postgraduate medical trainees, investigating both situational and personal aspects. Exploratory factor analysis was used to identify the constructs captured by the questionnaire, and reliability was assessed by estimating Cronbach’s alpha. Construct-specific scores were computed, and their correlation with established pre-validated scales (criterion validation) was assessed. Four factors—“stress”, “coping”, “empathy”, and “trauma”—explained 50% of data variability and demonstrated satisfactory overall internal consistency (Cronbach’s alpha = 0.76). Significant correlations were found between the “stress” score and the “emotional exhaustion” component of the Maslach Burnout Inventory (MBI) (r = −0.76), the “coping” score and the “positive attitudes” component of the Coping Orientation to Problems Experienced Inventory (COPE) (r = 0.46), and the “empathy” score with the “empathic concern” (r = 0.52), “fantasy” (r = 0.41), and “perspective taking” (r = 0.45) components of the Interpersonal Reactivity Index (IRI). No significant differences in scores were found in terms of gender or medical specialization. This study suggests that the SCOPE questionnaire may be a promising tool for assessing workplace stress and psychological responses among medical residents. Full article

The scientific literature focused on the categorization of therapists’ interventions in clinical sessions, and their effects on patients, is not very extensive and often autoreferential. The most relevant findings clearly show the eclecticism of clinicians, grounding only 10–14% of their interventions on the specific theoretical approach to which they belong. Despite that, a trans-theoretical systematization of clinical interventions is lacking. The present work aims to verify the feasibility of a trans-theoretical categorization of clinical interventions based on Dynamical Systems Research in psychotherapy (DSR). For this purpose, the authors present the results of three literature reviews. The first sections of this paper present the literature on the historical development of clinical interventions within the psychodynamic and cognitive-behavioral approaches. In the fourth section, the review of the DSR literature in psychotherapy and the systematization of clinical interventions according to such a unifying framework are introduced. Clinical interventions can be aimed at increasing the patient’s stability and flexibility, with the final objective of promoting H-L Synchronization and S-F Oscillations. The connections between the DSR-based categorization and the literature pertaining to the psychodynamic and cognitive-behavioral approaches are highlighted. Finally, in the conclusions, the limitations and potential developments of this scientific area are discussed. Full article

Suicidal behavior is an important public health problem often associated with psychological and biological factors. Understanding the role of biochemical markers, such as cholesterol and serotonin levels, may provide insight into the mechanisms underlying suicidal tendencies. This study aimed to investigate the relationship between lipid profile parameters, serotonin levels, and psychological status in individuals who had attempted suicide. Patients with suicidal attempts underwent a psychiatric evaluation and blood samples were taken to measure serotonin levels, total cholesterol, and lipid metabolism parameters. Psychological assessments included measures of depression, stress, and hopelessness; assessments of motivation; suicidal tendencies; and assessments of psychological and physical aspects of fear of death. The study found a significant positive correlation between serotonin and cholesterol levels (r = 0.6883, p < 0.0001). Lower levels of serotonin and cholesterol were associated with higher rates of depression and stress. These findings suggest that dyslipidemia may be associated with reduced serotonin function, which may contribute to the development of suicidal behavior. The study highlights the potential role of cholesterol and serotonin in the development of suicidal behavior, along with the mental status of patients. Evaluating the interaction of neurobiological and social–psychological factors provide an opportunity to search for peripheral biomarkers of suicide risk. Full article

Substance-induced psychosis (SIP) is an increasingly prevalent and complex condition that presents significant diagnostic and therapeutic challenges. With the rising use of novel psychoactive substances (NPSs) and potent traditional compounds like cannabis and cocaine, particularly among adolescents and young adults, understanding the mechanisms and clinical manifestations of SIP has become more critical. This review examines the psychopathological characteristics of SIP, focusing on the differentiation between substance-induced and primary psychotic disorders. Two key concepts are explored: Gaëtan de Clérambault’s “mental automatism”, which describes involuntary thoughts and sensations experienced as alien to the self, and the “twilight state” of consciousness, characterized by an altered perception of space, time, and social interaction. These phenomena are essential in understanding how substance use triggers psychotic processes and how SIP differs from endogenous psychosis. This review also highlights the clinical and phenomenological distinctions between acute and chronic psychotic episodes, emphasizing the potential transition from SIP to persistent psychosis, especially in cases of frequent and potent substance use. It discusses the diagnostic and therapeutic importance of recognizing specific psychopathological markers such as alterations in temporality, spatiality, and intersubjectivity. Understanding these features enhances the clinician’s ability to accurately differentiate SIP from primary psychotic disorders, which is often complicated by the widespread use of substances that may not be easily detectable in standard tests. This review concludes by advocating for a clinical–phenomenological approach to empathically engage with patients and provide a solid diagnostic framework for improved treatment strategies, particularly for those at risk of transitioning to chronic psychosis. Full article

This study investigates the impact of psychiatric interventions on occupational dysfunction in patients with major depressive disorder (MDD) and anxiety disorder (AD). Occupational dysfunction is a significant concern in these populations, severely impairing the ability to perform daily activities and fulfill work and social roles. This research seeks to evaluate how different psychiatric interventions, including pharmacotherapy and psychotherapy, affect patients’ occupational performance and overall quality of life. This study analyzed data from outpatients diagnosed with MDD and AD based on ICD-10 criteria. Participants were assessed before and after intervention using scales that measure anxiety, depression, and occupational task difficulty. Results demonstrated a significant improvement in patients’ ability to perform a wide range of tasks, including personal hygiene, work-related activities, and social engagement, following treatment. The study highlights the importance of a multidisciplinary approach, emphasizing that both pharmacotherapy and psychotherapy significantly contribute to reducing occupational dysfunction and enhancing quality of life. These findings underscore the need for tailored interventions that address the specific occupational challenges faced by individuals with MDD and AD, aiming for long-term functional recovery. Full article

The aim of this study was to assess the mental health situation of children and adolescents during a period of less strict COVID-19-pandemic-related measures after the first pandemic wave. This cross-sectional study was conducted in July 2021 by carrying out an online survey among children and adolescents (aged 10–18 years) from Halle (Saale), Germany (n = 233). The questionnaire measured important aspects of mental health among young people, namely health-related quality of life (HRQoL, using the self-report version of the KIDSCREEN-10), mental health problems in general (using the SDQ), depressive symptoms (using the CES-DC), and psychosomatic complaints (using the HBSC symptom checklist). In addition, other important health issues such as sleep behavior and related difficulties, disordered eating, and any positive consequences of the pandemic were addressed. The results were analyzed using descriptive statistics. A total of 223 children participated in the survey. About 69.7% of the participating children and adolescents had a high HRQoL, while 10.5% displayed abnormal results on the SDQ. There were indications of emotional problems in 16.5% of the participants based on the SDQ subscales. Almost 44% of the participants were screened as positive for depressive symptoms on the CES-DC, with girls and older adolescents being more likely to be affected. This also applied for psychosomatic complaints. Here, irritability was experienced at least once a week or more frequently by 58.9% of the children and adolescents. Although we had a small sample size, this study showed a high prevalence of mental health problems regarding the SDQ and HRQoL. However, our study population showed a better mental health than comparable studies conducted earlier in the pandemic. Depressive symptoms were still substantially higher than those in pre-pandemic data. We hypothesize that this might reflect the fact that there were a few COVID-19-related restrictions at the time when our survey took place. Based on these findings, we assume that the mental health of children and adolescents differed between different phases in the pandemic. Full article